| NPI | 1730468273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R872659) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 16041) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2016-03-09 |